| Background:Helicobacter pylorus (Hp) is a micro-aerobic/gram-negative spiral bacteria isolated by Marshall and Warren in Australia in 1982 from chronic active gastritis and gastric biopsies of patients. Its name originates from its appearance under light microscope. The source of infection is only human. There are two routes of transmission:one is oral-oral route; the second is fecal-oral route. Most people are susceptible to Hp and lack of effective and lasting immunity. Helicobacter pylori (Helicobacter pylori, Hp) infection rate is more than 50% in Global natural populations. Hp infection attracts great attention increasingly, and develope into a worldwide problem.Hp not only results in chronic gastritis and peptic ulcer, but also is a risk factor for gastric cancer. Hp is currently considered to main reasons accounting for chronic active gastritis, duodenal and peptic ulcer. In addition to be highly relevant to chronic inflammation of the digestive tract, peptic ulcer, gastric cancer and other diseases, current epidemiological survey also show that Hp is related to many parenteral diseases Such as coronary heart disease, membranous nephropathy, oral ulcers, thrombocytopenic purpura, cerebrovascular disease and children stunting. Chinese Medical Association launched a large-scale survey of Hp epidemiology involving 39 nationwide centers in 19 provinces and cities. The results showed the general Hp infection rate was 40.1%-90%, an average of 59%. Hp infection rate is the lowest in Guangdong Province (42%). Epidemiological data indicate that overall Hp infection rate was 55.5% in patients without gastrointestinal symptoms,66.4% in patients with gastrointestinal symptoms.It is worth noting, although the infection rate of more than 50% or more, there exists delay medical phenomenon partly due to low awareness. Chen Shiyao found that in Shanghai rate of awareness of Hp infection and risk factors was 33.2%, only 23.8% of the people know transmission of Hp. Our investigation showed that Hp awareness in Guangzhou is only 25% of the population, and most people did not understand the relevant knowledge on the Hp. A minority of people infected with Hp appear gastrointestinal discomfort. Meanwhile, many patients have been infected before appearance of gastrointestinal discomfort, so they absolutely are not aware of them. Moreover, more patients with Hp infection did not take the initiative to contact the doctor immediately, even if there were gastrointestinal symptoms which is mild and appeared not to affect daily life and work. And when they seek medical treatment when serious illness developed, they had lost the good opportunity of early treatment. Some patients with Hp infection might seek medical attention because of discomfort; however the medical procedure is unsatisfactory. It might include out-patient diagnosis and patient treatment, but post follow-up was poor. So often they were unable to complete the entire course of treatment or could not be regularly review. In short, Hp infection has not yet attracted enough attention.With extensive application of modern antibiotics, antibiotic resistance rate increased gradually, the eradication rate of triple therapy is not satisfactory. Many studies showed that, PPI+clarithromycin+amoxicillin triple therapy to eradicate Hp has fallen to below to 80%. Hp infection treatment is currently still am arduous task, although the medical personnel at home and abroad cure of patients infected with Hp with increasing depth. Besides study on medicine protocols, drug resistance etc, how to improve the awareness of patients, treatment compliance and reduce the relapse rate is an important issue.Gisbert consider the prescription compliance as the first factor in the eradication of Hp. Proper guidance to patients infected with Hp could improve the cure rate of Hp. How to improve treatment compliance, self-health management and encourage them to participate in the course of treatment actively is worth thinking deeply.With the rapid development of modern society disease spectrum has undergone great changes which is gradually moving from infectious diseases to chronic non-communicable diseases. Due to poor lifestyle hypertension, diabetes, Hp infection and other serious threat to human health emerged. Because Gastrointestinal disease is universal, multiple and common, the lifestyle leading to these diseases has not yet attracted enough attention. Patients infected with Hp need systematic and standardized health management. Currently hysteretic health management pattern impede the success treatment of Hp.The traditional "disease-centered" medical model has been unable to meet new challenges, health management and health services as a forward-looking model, become more and more important. Health Management (health management) refers to a comprehensive procedure monitoring, analysis, assessment of health risk factors to individuals or groups. It includes health monitoring, health assessment, health maintenance, and health promotion. Mobilizing initiatives of individuals and the community, effective use of limited resources to maximize health outcomes and strengthen the health management of the general population has become an urgent public health problem to be solved. Joshua et at studies have shown that the management of patients with Hp infection can increase the cure rate and improve the quality of life. Scientific and rational health management and health promotion to patients with Hp infection is essential and necessary.Research purposesThrough investigation of Helicobacter pylori infection, to understand the epidemiology of Hp infection and reasons accounting for postponement of hospitalization, to explore patients' medication compliance and their impact factors; to apply health education to improve the awareness, treatment compliance and satisfaction with health education rate. To provide theoretical basis for high-quality nursing care and health education, furthermore realize the systematic health management for patients with Hp infection.Objects and Methods1. The first part. Investigation of relevant factors of Helicobacter pylori infection in GuangzhouThe study subjects were patients seeking treatment e.g. gastroscopy because of upper abdominal pain, bloating, acid reflux, belching and heartburn and other stomach problems in 3 hospitals in Guangzhou from March 2009 to June 2009. It sums 660 cases.After 62 cases of pre-investigation, based on literature and clinical and nursing advice based on expert opinion, the questionnaire was revised repeatedly until completion. The internal consistency reliability coefficient (Cronbach's a) was 0.847. The questionnaire is divided into three sections:general information, diet and lifestyle questionnaire, the international general self-rating anxiety scale (SAS). General information includes:gender, age, marital status, education, occupation, incoming and past medical history, etc. Eating habits and lifestyle questionnaire includes:rice, meat., eggs, beans, vegetables, smoked, green tea, fruits, milk, yogurt, herbal tea, etc. International standard self-rating anxiety scale (SAS) measure anxiety in patients.Diagnostic criteria of Hp infection:patients' positive Hp infection when result of rapid urease test (RUT) is positive according to "LuShan consensus" in the diagnostic criteria for Hp infection in 2007.Criteria of patients' selection for investigation:normal spirit, thinking and memory ability, full ability to communicate in Chinese, clearly understand and answer the questions asked. No primary heart, lung, brain, kidney and other serious diseases. Be voluntary to participate in this study. Questionnaires with uniform instructions were completed with on-site methods. The validity of data was checked by hand on a unified model including carefully examination of the entry. Then original data was input to computer. SPSS 13.0 software was used for statistical analysis. Applying chi-square test, rank sum test and multivariate logistic regression to analyze factors related to Hp infection.2. The second part. Qualitative research of postponement of hospitalization in patients infected with Hp.12 patients were selected for in-depth interviews individually. The researchers collected the raw data during interviews. After finishing interviews, researchers analyze the information, summarizing all views and perspectives and find out the key points of view.3. The third part. Health management of patients with Hp infection.60 patients were selected who were diagnosed Positive Hp patients with RUT by gastroscopy.60 cases were divided into two groups:experimental and control group, 30 patients respectively. Gender, age and education level were not statistically significant between two groups. Experimental group was conducted with health management by researcher and control group was conducted with traditional health education. After 1 month all patients were follow-up by telephone by researchers. Hp-related knowledge awareness, treatment compliance, satisfaction survey of two groups were analyzed with SPSS 13.0 software.Results1. Analysis of related factors of Hp infection:The total prevalence of Hp infection was 47.9% in patients with stomach disorder. Hp infection was no different between gender (P>0.05), although Hp infection appear to be slightly more prevalent in male than in female. However, the prevalence increased by year (P<0.01). Moreover, Hp infection and digestive diseases are closely related. Among the diet-related factors, yoghurt consumption, drinking green tea and eating beans appears to decrease the prevalence of infection. Pickled food was a risk factor. Among Socio-economic factors, education levels and incoming is protective. Smoking, insomnia and anxiety are risk factors to Hp infection in lifestyle.2. Results of qualitative research:After a series of in-depth analysis, five factors were found to influence the hospitalizing decision for patients with Hp infection including:knowing little about H.pylori infection, underestimating the severity of disease, lacking knowledge of early medical treatment, unwilling to face the disease and poor economic conditions.3. Evaluation of health management of patients infected with HpHp eradication rate of experimental group and control group was 86.67% and 76.67% respectively. This result showed a declining trend, although it is not significant (P> 0.05). Larger sample size for health management may improve statistical efficiency. Knowledge of Hp awareness, treatment compliance and education satisfaction was higher in the experimental group (P<0.05).Conclusion 1. Antibiotics or to improve the risk factors to decrease Hp infection is important measure to management for gastrointestinal diseases. Following the latter, some risk or protective factors were found in our study, which would be important for next health management for patients with Hp infection.2. Through qualitative research methods, reasons leading to postponement of hospitalization in patients with Hp infection were analyzed in-depth. In addition to cognitive ability, psychological, economic and social environment factors also influence the hospitalizing decision for patients with Hp infection. Unimpeded access to the channel knowledge of the disease, good health education, enhanced diagnosis and treatment technology and a sound health care system would be benefit to early detection and diagnosis for Hp infection.3. We got good results in health management for individual patients with Hp infection including:more Hp-related knowledge, better medication compliance and satisfaction with health education in patients with Hp infection.In this study, a series of investigation and analysis, qualitative research and corresponding health management were carried out. Our results shown systematic health management would effectively improve the quality of life of patients with Hp infection. |
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